[妇产科剖腹手术中抗粘连剂的临床应用价值]

Liu Mei-Mei, Li Pei-Ling

Department of Obstetrics and Gynecology, Second Affiliated Hospital, Harbin Medical University, Harbin 150086, China.

Zhonghua Fu Chan Ke Za Zhi. 2012 Apr;47(4):255-8.

OBJECTIVE

To investigate clinical value of anti-adhesion agent:chitosan in preventing adhesions followed by laparotomy surgery in obstetrics and gynecology.

METHODS

From Jan. 2006 to Dec. 2009, 770 patients underwent laparotomy surgery at Department of Obstetrics and Gynecology in the Second Affiliated Hospital of Harbin Medical University. One hundred and twenty-five patients underwent secondary surgery due to disease recurrence or cesarean section, the previous surgery were 18 cases with myomectomy, 20 cases with endometriosis surgery, 5 cases with resection of pelvic abscess, 20 cases with ectopic pregnancy surgery, 27 cases with benign adnexal neoplasm resection, 9 cases with cyto-reductive surgery in ovarian cancer, 26 cases with variable infertility surgery. Those 125 patients were managed by different agents washing before abdomen closure, which were assigned into two groups, including 59 cases washed by saline in control group and 66 cases washed by chitosan in study group. The abdomen adhesion in secondary surgery was evaluated by adhesion classification system.

RESULTS

In study group, 37 patients without adhesions, 20 patients with degree I adhesion, 6 patients with degree II adhesion, 3 patients with degree III adhesion, and no patients with degree IV adhesion were observed. While in control group, there were 11 patients without adhesions, 23 patients with degree I adhesion, 14 patients with degree II adhesion, 8 patients with degree III adhesion, and 3 patients with degree IV adhesion. The distribution of adhesion reached statistical significance between the two groups (χ(2) = 20.9999, P = 0.0003). Twenty-six patients in previous surgeries due to infertility included 17 cases in control group and 9 cases in study group. They all were managed by cesarean section in secondary surgery, it was found that 15 cases without adhesion and 2 cases with degree I adhesion were in study group and 2 cases without adhesion and 7 cases with degree I adhesion were in control group. It reached statistical difference (P = 0.0016).

CONCLUSION

Anti-adhesion agent could prevent adhesion followed by surgery in obstetrics and gynecology effectively.

目的

探讨抗粘连剂壳聚糖在预防妇产科剖腹手术后粘连中的临床价值。

方法

2006年1月至2009年12月，哈尔滨医科大学附属第二医院妇产科770例患者接受剖腹手术。125例患者因疾病复发或剖宫产接受二次手术，既往手术包括子宫肌瘤切除术18例、子宫内膜异位症手术20例、盆腔脓肿切除术5例、异位妊娠手术20例、良性附件肿瘤切除术27例、卵巢癌肿瘤细胞减灭术9例、不明原因不孕症手术26例。这125例患者在关腹前用不同药物冲洗，分为两组，对照组59例用生理盐水冲洗，研究组66例用壳聚糖冲洗。二次手术时通过粘连分类系统评估腹部粘连情况。

结果

研究组中，观察到37例无粘连，20例I度粘连，6例II度粘连，3例III度粘连，无IV度粘连患者。而对照组中，11例无粘连，23例I度粘连，14例II度粘连，8例III度粘连，3例IV度粘连。两组粘连分布差异有统计学意义（χ(2)=20.9999，P = 0.0003）。既往手术因不孕症的26例患者中，对照组17例，研究组9例。二次手术均行剖宫产，研究组发现15例无粘连，2例I度粘连，对照组2例无粘连，7例I度粘连。差异有统计学意义（P = 0.0016）。